Search Results (428)

Background: Lung cancer remains one of the leading causes of cancer-related mortality worldwide. While most diagnoses occur in outpatient settings, a subset of cases are incidentally identified during emergency department (ED) visits. The clinical characteristics and treatment decisions of these patients, particularly in relation to social background factors such as living situation and access to primary care, remain poorly understood. Methods: We conducted a retrospective study of patients diagnosed with malignancies in the ED of a single institution between April 2018 and December 2021. Patients diagnosed with lung cancer within 60 days of an ED visit were included. Data on demographics, disease status, treatment decisions, and background factors—including whether patients lived alone or had a primary care physician (PCP)—were extracted and analyzed. Results: Among 32,108 patients who visited the ED, 148 were diagnosed with malignancy within 60 days; 23 had lung cancer. Of these, 69.6% had metastatic disease at diagnosis, and 60.9% received active treatment (surgery or chemotherapy). No significant associations were observed between the extent of disease and either living arrangement or PCP status. However, the presence of a PCP was significantly associated with the selection of best supportive care (p = 0.023). No significant difference in treatment decisions was observed based on age (cutoff: 75 years). Conclusions: Although social background factors such as living alone were not significantly associated with cancer stage or treatment choice, the presence of a primary care physician was associated with a higher likelihood of best supportive care being selected. This may indicate that patients with an established PCP have more clearly defined care goals at the end of life. These findings suggest that primary care access may play a role in shaping end-of-life care preferences, highlighting the importance of personalized approaches in acute oncology care. Full article

As climate change consequences intensify, higher education institutions (HEIs) have an opportunity and responsibility to model sustainable operations. This study examines how embracing shared knowledge and inclusion in sustainability decision making facilitates green human resource management (GHRM) efforts to invigorate organizational environmental performance. The study examines the effects of shared and inclusive governance on campus sustainability via a regression model and the mediating role of employee participation via a structural equation modeling approach. The results show that shared governance and inclusive governance positively predict the commitment of HEIs to reducing greenhouse gas emissions, and campus engagement mediates these relationships, underscoring the importance of participation. These findings align with stakeholder theory in demonstrating that diverse voices in decision making can enhance commitment to organizational goals like sustainability. The findings also highlight the importance of shared and inclusive governance arrangements at college campuses not only for ethical reasons but also for achieving desired outcomes like carbon neutrality. For campus leaders striving to “green” their institutions, evaluating cross-departmental representation in governance structures and promoting inclusive cultures that make all students and staff feel welcome appear as important complements to GHRM practices. Full article

This article examines how religious freedom is enacted and redefined through everyday practices in pluralistic urban settings. Moving beyond the classical notion of negative liberty as non-interference, it explores the social conditions that enable or constrain the practical expression of religious life. Drawing on forty-three qualitative interviews with religious leaders and civic actors in Florence, Italy, the study analyses how religious freedom is experienced across institutional contexts such as hospitals, schools, prisons, workplaces, and sport facilities. The findings reveal a persistent tension between formal legal rights and their uneven implementation in daily life. While legal guarantees are generally upheld, structural barriers and discretionary practices often hinder access to religious expression. At the same time, informal interactions, local networks, and dialogical engagement play a key role in supporting the concrete exercise of religious freedom. The article argues that freedom is not simply a legal status but a social process, realized through relational and institutional arrangements. By foregrounding the role of everyday interaction in shaping the conditions of freedom, this study contributes to broader sociological debates on pluralism, normativity, and the social foundations of institutional life. Full article

The UI GreenMetric World University Ranking has become a widely adopted instrument for benchmarking institutional sustainability performance; nevertheless, empirically grounded evidence from universities in diverse regional contexts remains scarce. This study undertakes a rigorous appraisal of the extent to which Mahasarakham University (MSU) has institutionalized the United Nations Sustainable Development Goals (SDGs) within its pedagogical offerings, research portfolio, community outreach, and governance arrangements during the 2021–2024 strategic cycle. Employing a mixed-methods design and guided by the 2024 UI GreenMetric Education and Research indicators, this investigation analyzed institutional datasets pertaining to curriculum provision, ring-fenced research funding, 574 peer-reviewed sustainability publications, student-led community initiatives, and supporting governance mechanisms; the analysis was interpreted through a Plan–Do–Check–Act management lens. The number of sustainability-oriented academic programs expanded from 49 to 58. Student participation in community service activities strongly recovered following the COVID-19 pandemic, and MSU’s GreenMetric score increased from 7575 to 8475, thereby elevating the institution to the 100th position globally. These gains were facilitated by strategic SDG-aligned investment, cross-sector collaboration, and the consolidation of international partnerships anchored in Thailand’s Isaan region. The MSU case provides a transferable model for universities—particularly those operating in resource-constrained contexts—endeavoring to align institutional development with the SDGs and internationally recognized quality benchmarks. The findings substantiate the capacity of transformative education and applied research to engender enduring societal and environmental benefits. Full article

This study examines the role of supervisory frameworks in shaping the risk management behavior of Greece’s four systemic banks during the period of 2015–2024. It explores how regulatory reforms under Capital Requirements Regulation II, Basel III, and European Central Bank oversight influenced capital adequacy, asset quality, and liquidity metrics. Employing a quantitative methodology, this study analyzes secondary data from Pillar III disclosures, annual financial reports, and supervisory statements. Key risk indicators (capital adequacy ratio, non-performing exposure ratio, liquidity coverage ratio, and risk-weighted assets) are evaluated in conjunction with regulatory interventions, such as International Financial Reporting Standards 9 transitional relief, the Hercules Asset Protection Scheme, and European Central Bank liquidity measures. The findings reveal that enhanced supervision contributed to improved resilience and regulatory compliance. International Financial Reporting Standards 9 transitional arrangements were pivotal in maintaining capital thresholds during stress periods. Supervisory flexibility and extraordinary European Central Bank support measures helped banks absorb shocks and improve risk governance. Differences across banks highlight the impact of institutional strategy on regulatory performance. This study offers a rare longitudinal assessment of supervisory influence on bank risk behavior in a high-volatility Eurozone context. Covering an entire decade (2015–2024), it uniquely links institutional strategies with evolving regulatory frameworks, including crisis-specific interventions such as International Financial Reporting Standards 9 relief and asset protection schemes. The results provide insights for policymakers and regulators on how targeted supervisory interventions and transitional mechanisms can enhance banking sector resilience during protracted crises. Full article

Rural tourism has emerged as an efficient strategy for rural revitalization while having various impacts on rural governance. Previous studies predominantly focused on the social implications of rural tourism and its impact on institutional arrangements while neglecting the influence of rural tourism on collective action in rural governance. This study employed a social–ecological system (SES) framework to investigate the influence of rural tourism on rural collective action, utilizing survey data from 22 provinces (autonomous regions and municipalities directly under the central government), 178 villages, and 3282 rural households across China. The findings revealed that rural tourism exerted a positive influence on collective action, primarily through labor force reflow mechanisms. Specifically, the leadership of village cadres had a moderating role in enhancing this positive correlation. Further analysis revealed significant heterogeneity in tourism governance effects: non-plain regions and villages with medium to low economic development levels exhibited substantial improvements in collective action, whereas plain areas and economically advanced villages may manifest potentially negative impacts. Theoretically, this study contributes to elucidating tourism-driven self-governance mechanisms by applying the SES framework, thereby transcending the traditional dualistic debate between state-market and development-governance paradigms. Practically, we propose institutional designs that embed collective action mechanisms into the coupled synergistic development of rural tourism and community governance, thereby activating endogenous motivations for rural self-governance. Full article

This study explores the evolution of China’s intangible cultural heritage (ICH) governance through the lens of discursive institutionalism, with a specific focus on how institutional discourse and arrangements shape the spatial configuration and symbolic meaning of ICH-related landscapes. By analyzing policy discourse, governance actors, resource mobilization, and regulatory mechanisms, the study traces the transition from community-led practices to increasingly formalized and spatialized systems under the influence of the 2003 UNESCO Convention. Drawing on a combination of historical policy analysis and place-specific institutional insights, the research finds that while institutional reforms have enhanced administrative coherence and international alignment, they have also at times disrupted vernacular meanings and weakened residents’ place-based cultural attachments. Conversely, localized revitalization initiatives can foster community resilience and landscape justice. These findings are derived from an interpretive synthesis of institutional trajectories and spatial governance practices. Overall, the study contributes to the theoretical integration of discursive institutionalism and cultural geography, offering new insights into heritage governance and sustainable cultural planning in rapidly urbanizing contexts. Full article

Community-Based Forest Management (CBFM) efforts are critical for sustainable natural resource governance in Northwest Ethiopia. This study investigated the various aspects of CBFM, emphasizing practical implementation in the context of the Awi Administrative Zone, Northwest Ethiopia. A structured questionnaire was handed out to 412 farmers across three districts—Dangila, Fagita Lokoma, and Banja. The quantitative data was analyzed using the Likert scale with SPSS version 23 software. Findings indicate that insufficient financial support (44%), limited community participation (30%), and weak institutional arrangements (19%) are the major factors impeding effective CBFM, with statistically significant regional variation (χ² = 242.8, df = 3, p = 0.000). On the other side, increased awareness and international support (34%) and enhanced local participation (36%) were the leading facilitators (χ² = 512.05, df = 11, p = 0.000). We look at the practical aspects of CBFM, from community-led conservation efforts to sustainable harvesting techniques, emphasizing the importance of indigenous knowledge alongside modern methodologies. The CBFM project in the northwest part of Ethiopia have facilitated biodiversity protection and environmental resilience by integrating local perspectives with broader developmental goals. However, obstacles such as land tenure, resource conflicts, and capacity restrictions continue, requiring adaptive methods and legislative reforms. This paper contributes to the ongoing discussion on sustainable natural resource management by offering empirical insights into the dynamics of CBFM in the Awi administrative zone of northwest Ethiopia. Full article

Violence against people with albinism (PWAs) in Tanzania continues nearly two decades after mass media reported the first incidents in the mid-2000s. The violence is linked to organ trafficking for use in “magical rituals” that allegedly help politicians and businesspeople to succeed in their endeavors. Over time, as societal awareness grows, the attacks become increasingly clandestine and complex. PWAs themselves, the public, and gray literature frequently relate the violence to the increased political and economic activity and participation following Tanzania’s adoption of political and economic liberalization. However, scholarly research is either silent or mentions the occult practices only in passing. This paper, therefore, explores Tanzania’s institutional arrangements both driving the violence and crippling the efforts at promoting the rights and welfare of PWAs in the wake of increasing political and economic participation in the country. It discusses the ways in which violence against PWAs has evolved alongside political and economic dynamics from the time such incidents came to public attention until the present. I argue that the current approach, whereby advocacy about the rights of PWAs relies on appeasing the state, appears to perpetuate the very beliefs and practices driving the violence. The exploration makes use of first-hand experience through my participation in numerous formal and informal interactions with PWAs, internal and external meetings within the Tanzania Albinism Society (TAS), interviews, and gray literature on the subject. Full article

This paper revisits the international finance trilemma by analyzing how different monetary policy objectives and exchange rate regimes shape the transmission of global risk shocks. Using a structural vector autoregressive model with exogenous variables (SVARX), we examine the monetary policy responses and exchange rate fluctuations of ASEAN+4 economies—China, Japan, Korea, and Hong Kong—to external shocks including U.S. monetary policy changes, oil price fluctuations, global policy uncertainty, and financial risk during 2010–2022. Economies are grouped according to their trilemma configurations: floating exchange rates with free capital flows, fixed exchange rates, and capital control regimes. Our findings broadly support the trilemma hypothesis: fixed-rate economies align with U.S. interest rate movements, capital control economies retain greater monetary autonomy, and open, floating regimes show partial responsiveness. More importantly, monetary responses vary by global shock type: U.S. monetary policy drives the most synchronized policy reactions, while oil price and uncertainty shocks produce more heterogeneous outcomes. Robustness checks include alternative model specifications, where global shocks are treated as endogenous, and extensions, such as using Japan’s monetary base as a proxy for unconventional monetary policy. These results refine the empirical understanding of the trilemma by showing that its dynamics depend not only on institutional arrangements but also on the nature of global shocks—underscoring the need for more tailored and, where possible, regionally coordinated monetary policy strategies. Full article

Under the context of increasing demand for transparency, efficiency, and trust in food systems, digital traceability is emerging as a key strategy for improving value creation across agri-food supply chains. This study investigates how different governance structures influence the design and effectiveness of digital traceability systems. We develop an analytical framework linking four guiding questions (why, where, how, and who) to traceability performance and apply it to five Italian supply chains (wine, olive oil, cheese, pasta, and dairy) through 28 semi-structured interviews with companies, cooperatives, and technology providers. The results show that governance models shape traceability adoption and function. In captive systems (e.g., wine), traceability ensures compliance but limits flexibility, while in modular or relational systems (e.g., pasta and cheese), it fosters product differentiation and decentralized coordination. Across cases, digital traceability improved certification processes, enhanced consumer communication (e.g., via QR codes), and supported premium positioning. However, upstream–downstream integration remains weak, especially in agricultural stages, due to technical fragmentation and limited interoperability. The diverse experience data from company interviews reveal that only 30% of firms had fully integrated systems, and fixed costs remained largely unaffected, though variable cost reductions and quality improvements were reported in the olive oil and cheese sectors. The study concludes that digital traceability is not only a technical solution but a governance innovation whose success depends on the alignment between technology, actor roles, and institutional arrangements. Future research should explore consumer-side impacts and the role of public policy in fostering inclusive and effective traceability adoption. Full article

Public welfare land allocation in China’s land expropriation process plays a crucial role in balancing economic development with social equity, but limited research has examined the driving factors influencing public welfare land ratio determination from a central–local relationship perspective. This study investigates how central–local government interactions shape public welfare land ratios in China’s land development process. Based on a comprehensive analysis of land expropriation data across different regions and administrative levels, we examine the spatial heterogeneity and underlying mechanisms of public welfare land allocation. The results reveal the following: (1) Significant regional variations exist for regional public welfare land ratios, with the national average public welfare land ratio reaching 41.21% in 2019 (for plots ≥4 hectares), varying from 39.60% in eastern regions to 44.93% in western regions. (2) Administrative hierarchy influences allocation patterns, with county-level cities (43.73%) showing higher proportions than provincial capitals (36.42%). (3) Local governments strategically use public welfare land development as an instrument to expand land-based fiscal resources by attracting investments and population. (4) Provincial governments serve as crucial intermediaries in central–local policy implementation, balancing central mandates with local conditions. This study contributes to the land governance literature by providing empirical evidence on how institutional arrangements affect land resource allocation. The findings suggest that establishing unified national standards while allowing provincial-level adaptations would improve the effectiveness of public welfare land policy in the post-land finance era, enhancing both governance efficiency and public welfare outcomes. Full article

Agroforestry systems (ASs) are increasingly recognized as effective strategies for ecological restoration and sustainable land use in semi-arid regions. This study aimed to evaluate the implementation and early outcomes of an AS established in a degraded urban area in the Brazilian semi-arid region. Specifically, we analyzed the system’s establishment process, estimated its costs, assessed structural development over time, and compared species performance and carbon accumulation across different biodiversity arrangements. After three years, the system accumulated 17.69 Mg ha⁻¹ of carbon and demonstrated significant basal area growth, particularly among fast-growing species such as Ceiba glaziovii, Gliricidia sepium, and Moringa oleifera. These species enhanced overall system productivity and likely contributed to increases in soil organic matter, facilitating the establishment of more demanding, slow-growing species. Cost analysis indicated a total implementation and maintenance estimate of BRL 57,468.79 ha⁻¹ (USD 11,096.29) over three years, with irrigation and maintenance accounting for 44.39%, labor and site preparation 31.59%, and seedling production 24.02%. Although the system proved viable under institutional support, its replicability for smallholders remains dependent on reliable water access or implementation aligned with the rainy season. The use of nursery seedlings enhanced seedling survival and system feasibility. The broader adoption of agroforestry in semi-arid regions will require supportive public policies and technical assistance. Strengthening government programs such as PNAE and PRONAF is essential, as these initiatives can promote system adoption by facilitating access to credit while also reducing costs, particularly when short-cycle crops grown within the system are sold to local schools. It is important to note that agroforestry costs vary depending on the intended objectives, species diversity, and arrangement design. Therefore, technical assistance is critical to guiding smallholders in selecting and implementing context-appropriate systems. Our findings reinforce the potential of agroforestry systems to promote carbon sequestration, restore degraded lands, and support food security and sustainable development in climate-vulnerable regions. Full article

Urban flooding represents a critical socio-ecological challenge exacerbated by climate change and rapid urbanization, with green infrastructure (GI) emerging as a transformative approach to flood management. This study employs an innovative methodological framework integrating the Biblioshiny, CiteSpace, and Orange3 analytical tools to examine research trends and evolutions in GI for urban flooding from 2015 to 2024. The bibliometric analysis of 813 publications reveals a profound epistemological transition from technically oriented approaches toward integrated socio-ecological frameworks. The citation patterns demonstrate increasing scholarly attention on multifunctionality, climate resilience, and governance dimensions, with the United States and China emerging as dominant research hubs. The analysis identifies distinct thematic clusters reflecting the field’s intellectual progression from hydrological engineering paradigms toward systemic conceptualizations that recognize the complex interactions between technical, ecological, and social dimensions. Despite these advancements, persistent knowledge gaps remain regarding longitudinal performance evaluations, governance frameworks for maintenance, and scalar integration from site-specific interventions to watershed-level outcomes. These findings emphasize the need for methodological innovation addressing the temporal dimensions of GI performance and institutional arrangements for its implementation across diverse urban contexts, positioning GI as a critical component of sustainable urban water management amid increasing climatic uncertainty. Full article

Background and Objectives: Sternal resections, although rare, pose significant challenges for the reconstruction of large anterior chest wall defects. Both stability and soft tissue reconstruction are essential for preventing respiratory complications and ensure structural stability. Despite the variety of techniques proposed, no consensus exists on an optimal method. Herein, we present our institutional experience using the novel “spider-web” technique combined with an anterolateral thigh (ALT) free flap for chest wall and soft tissue reconstruction following extensive sternectomies. Materials and Methods: Between January 2023 and November 2024, five female patients underwent partial or total sternectomy for oncologic indications. Chest wall stability was restored using the “spider-web” technique–based on non-resorbable polyester threads arranged in a geometric web pattern reinforced with polypropylene mesh–followed by soft tissue reconstruction using a free ALT myocutaneous flap. Data on demographics, surgical details, postoperative outcomes, and complications were prospectively analyzed. Results: Resections included two partial and three total sternectomies. The mean operative time was 385 min (range: 330–435 min). All patients were extubated postoperatively without the need for respiratory support. The “spider-web” construct provided adequate chest wall stability with no cases of paradoxical movement or chronic pain. No flap loss occurred; one case required revision for venous thrombosis, and one hematoma at the donor site was evacuated. No infections or wound dehiscence were observed. The median hospital stay was 11 days (SD ± 1.67 days), and 30-day mortality was 0%. Median follow-up was 10 months (SD ± 6.55 months), without long-term complications. Conclusions: The “spider-web” technique, combined with ALT myocutaneous free flap, is a simple, reliable, and cost-effective method for the reconstructing extensive chest wall defects following sternectomy. Its technical versatility and favorable outcomes suggest it as a valuable option, offering both structural stability and soft tissue coverage with minimal morbidity. Full article